Conclusion: Motives for the WHO’s Tobacconization of all Industry
Why would supposedly responsible leaders propose such a reckless strategy?
The recent WHO report, entitled “Commercial determinants of noncommunicable diseases in the WHO European Region”, declared stakeholder dialogue dead and laid out a bold and dangerous strategy to exclude all “health-harming industries” (HHIs) from public discourse in the same manner the tobacco industry was isolated. This report was excessively divisive, obtuse and inherently stupid, namely:
In its dozens of case studies, the WHO indicated that almost all industries and commercial activities fall under their definition of “health harming” (including pharmaceuticals, food and drink, medical devices, nutritional supplements...). This would mean that the most important stakeholders in innovative public health fields would not be allowed to engage in policy debates or promote their technologies. See Part One.
In banning industry engagement, the WHO would create an unworkable public policy arena were policymakers would not be able to gather reliable information or work with key stakeholders on health strategies and innovative advances. This approach is mindboggling if one considers how we have just come out of a global pandemic where public-private partnerships were essential in saving lives, producing and distributing PPEs and vaccines and keeping supply chains open during lockdowns. See Part Two.
The WHO relentlessly attacked Corporate Social Responsibility (CSR) and industry’s efforts to engage with other stakeholders to find common ground. The authors of the report could not say anything positive about any corporate action to alleviate suffering during, for example, the pandemic. To them, the donated hospital ventilators, food aid, donations… were all seen as industry marketing scams to distract the public and policymakers from the damage their products are doing to global health. The WHO, in this report, seems incapable of accepting the possibility that industry actors can do the right thing because it is the right thing. See Part Three.
In isolating industry from engaging public discourse, the WHO promotes an alternative of more financial support and engagement with civil society organizations (CSOs) that include NGOs and activist groups. The report seems unaware of how these groups are also blinded by interests and funding commitments. It is a very weak alternative given that most CSOs do not have the research, production or logistics experience and understanding that industry has (and that are essential to promote better global health conditions). Excluding industry and further empowering a group of activist ideologues would impoverish health policy decisions. See Part Four.
The question for this concluding article comes down to the simple question: Why? Why would the WHO seek to unravel decades of stakeholder dialogue, engagement and participation? Many of the WHO staff have high education levels so why would they support such a dangerous and stupid strategy?
Unmanaged Militant Silos
The World Health Organization has become a Medusa with many heads. It essentially has two key health mandates: prevent global outbreaks, health inequities and the spread of communicable diseases on the one hand and reduce the impact of noncommunicable diseases (NCDs) on the other. Since the global campaign against tobacco and the setting up of the Framework Convention on Tobacco Control (FCTC), militants leading this wing of the WHO have become emboldened to extend such interventions.
As the WHO is a multitude of silos without management or political scrutiny (I have seen this with my own exposé of another WHO agency, IARC), program directors are free to say and do what they want while hiding under the blanket of WHO credibility. On NCDs, the healthcare community encompasses a wide spectrum of interests from the health gurus and zealots demanding zero risk to the pragmatists seeking health improvements and scientific solutions within a range of other cultural, economic and social factors. The WHO tries to please all silos within a big tent approach.
With this report demanding the tobacconization of all industries, the militants in this WHO faction are embarrassing others within the organization working so hard to promote public health in a reasonable manner. With competition between directors of sections, regions and agencies, with a wide variation in member state interests, with a voluminous cackle from activist CSOs, NGOs and arrogant academic health gurus (and with very little public, political or media reaction to such offensive strategies), the upper management is left with little option but to let the divisions manifest and pretend to speak with a single voice.
The WHO must be a horrible place to work where good talent is burnt, backbiting is the office dialogue and a helpless, hopeless management only show up because their salaries are high.
Following, not Leading
Part 4 of this Firebreak analysis illustrated how framework programs subcontract policy strategies and idea developments to consortia of likeminded thinking. I suggested that this report could have been a product of such an external, WHO-funded project (given that many of the authors are external to the WHO). In Part 2, I showed how the WHO was trying to catch up with a number of books, articles and a Lancet series condemning the commercial determinants on health (used so frequently within this activist clique that they have nominated an acronym: CDoH). The last paragraph of the WHO “ban industry” strategy document admits that: “In summary, this book aims to build on the surge in recent public health interest in CDoH,”
The WHO was late to the party (as seen with Ghebreyesus‘ article in the Lancet CDoH series) but felt it still had a role to play in isolating industry given the success they claim with the isolation and denormalization of the tobacco industry via the FCTC. It is one thing though for an academic or NGO activist to demand that all industries be excluded from the policy process, and quite another for a UN agency responsible for global health policies to follow them down that rabbit hole. Given how beneficial the public-private partnerships have been for the WHO and global health promotion, publishing such a strategy report to try to break up all corporate engagement was both stupid and dangerous.
Perhaps the fact that this report was released via the WHO Europe office and not via the WHO international office is an indication of dissent at the highest management levels toward such a radical strategy. But until the WHO can seriously speak with a single voice, such folly will continue to destroy its trust and reputation. A new leadership needs to clean up the militant factions and ensure a responsible management of global health policy.
The first step is quite easy: remove their terrible strategy publication, commit to stakeholder dialogue and issue an apology. But so long as the serpents are wrapped around Medusa’s head and not the Rod of Asclepius, the political infighting will keep the WHO unmanageable and uncredible.
Misplaced Blame in Disease Causation
The industry denormalization report is founded on a belief that most main noncommunicable diseases afflicting populations (cancer, heart and lung disease, diabetes…) can be attributed to poor lifestyle behavior (smoking, drinking, processed foods, sugars, chemicals…) and that individuals become sick due to being exploited by ruthless health-harming commercial interests. So the WHO’s conclusion seemed obvious: tobacconize all industries.
When you’re a hammer, everything looks like a nail. But not all noncommunicable diseases can be so easily explained away as corporate curses. A paper showing how up to two thirds of cancers were the result of bad luck tried to refocus the debate on health prevention measures. This caused a strong reaction in certain WHO agencies like the International Agency for Research on Cancer (IARC) whose monograph program is built on the belief that every cancer can be traced to a lifestyle or environmental cause.
But from a wider perspective, perhaps the WHO should be a bit more understanding and reasonable. A good amount of health improvements and disease cures are due to industry innovations and developments. We are living longer thanks to scientific and technological advances led by corporate research achievements (and in living longer, more health issues like cancers have time to develop, ie, good luck eventually runs out).
Misplaced Distrust of Individuals
In my article, “Who Made me Fat?”, I did a rare thing. I took responsibility for becoming obese. I also then credited the food industry for offering a wide selection of high-fiber, low-calorie products that enabled me to lose the weight and improve my overall health. I can understand that many people are vulnerable, face personal, emotional or cultural challenges to maintaining good health, but the food and drink industries offer a wide selection of choices that can also enable and empower people to keep to a healthy diet. Bottom line: health is personal. If there is a demand for weight-loss products, and in the Western, developed world, there is, then there is a market for industry.
The WHO report does not believe industry can be an honest broker here. But they also do not believe individuals can be trusted or empowered to manage their personal health choices. As the last section noted, they are calling for a “narrative shift” away from leaving health choices to individuals. In other words, they want the health gurus to impose their solutions.
I suspect for the zealots behind this WHO report, the food industry should be providing only natural food, all freshly picked directly from the branch, without packaging, processing or additives, all organic and all perfectly in line with my personal health requirements. But the earth does not rotate on such an ideological axis.
There are days when my emotional state may crave something sweet or with a pleasant texture. With my busy schedule, I cannot always find the time to prepare an all-natural meal from scratch so I appreciate being able to pop something already processed into the microwave. I may feel I need to relax with a beer, a vape or a whiskey to top off a stressful day. I know and manage the health risks and enjoy the benefits of my consumption choices. I would never appreciate the WHO relieving me of my individual choices by releasing an army of activists with their puritan health impositions to effect their radical systemic change. I would also not be able to afford the added costs of these impositions.
Most health options contain uncertainties (as surely as each person’s health needs is different). But uncertainty management (precaution) is no longer part of a normal risk management process. The WHO, in their report, is aware of this opportunistic policy tool.
NCD advocates can probably make stronger use of the precautionary principle in building common cause with environmental health and in ensuring that the regulatory environment protects the health of current and future generations.
The challenge here is that, with health issues, there is no certainty, so in any and all cases, the precautionary principle could be invoked to ban anything (vaccines, medicines, dietary requirements …). But as seen in environmental debates, the precautionary principle is only invoked as a policy tool to eliminate what activists do not like or are funded to campaign against (eg, banning synthetic pesticides but refusing to consider taking precaution on those pesticide substances approved for organic farming).
Would the WHO enforce a precautionary ban on coffee (given there is no certainty that the thousand plus chemicals in a single cup are not carcinogenic)? They would have to if they were to have any integrity backing up the claims in this anti-industry report.
Go away! We don’t need you … Until we do
And it seems integrity is what is terribly lacking within the WHO today. As one unit within the WHO attacks industry and stakeholder dialogue with a feral zeal, another unit, with other objectives, embraces industry for all of the good it can do in protecting global public health.
In Part 3, this analysis saw how a previous WHO leadership embraced the public-private partnership model to develop quick wins and better promote public health. Many NGOs working closely with the WHO, like GAVI and the NCD Alliance, developed close ties and cooperation with industry groups based on this preferred WHO strategy.
It was not that long ago that we were locking up populations in fear of an emerging respiratory disease that was rapidly spreading around the globe. The WHO, like everyone else, turned to industry for solutions only they could provide. In a press release on the day that most of the European Union imposed its first COVID-19 lockdown, this is what the WHO said about industry in a joint statement with the International Chambers of Commerce (ICC):
Governments should commit to making available all necessary resources to combat COVID-19 with the minimum of delay and to ensure that cross-border medical and other essential goods supply chains are able to function effectively and efficiently … As the pandemic evolves, ICC Secretary General John W.H Denton AO and WHO Director General Dr Tedros Adhanom Ghebreyesus will continue to coordinate their efforts.
When integrity is lacking, hypocrisy can fill the void. The WHO has some serious work to do to clean up its act. A first step is to remove its support for this divisive and dangerous report that seeks to exclude industry actors and commit to an open dialogue and engagement with all stakeholders.